Erschienen in:
01.04.2016 | Healthcare Policy and Outcomes
Financial Impact of Postoperative Complication Following Hepato-Pancreatico-Biliary Surgery for Cancer
verfasst von:
Faiz Gani, MBBS, John Hundt, MBA, Martin A. Makary, MD, MPH, Adil H. Haider, MD, MPH, Cheryl K. Zogg, MSPH, MHS, Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon.)
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 4/2016
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Abstract
Background
Despite increasing efforts for cost containment, little is known regarding the financial implications of postoperative complication under current volume-driven payment paradigms. This study sought the test the associations between hospital finances and postoperative complications among hepato-pancreatico-bilary cancer patients.
Methods
Patients undergoing surgery for the management of a hepatobiliary or pancreatic cancer between January 1, 2009 and December 31, 2013 were identified using institutional claims and cost-accounting data. Multivariable linear regression analyses were used to calculate risk-adjusted fixed and variable costs, payments, and net margins.
Results
A total of 1483 met inclusion criteria. Fixed ($9290 [interquartile range (IQR) $7129–$11,598] vs. $14,784 [IQR $10,523–$22,799], p < 0.001) and variable costs ($12,342 [IQR $9886–$14,762] vs. $19,330 [IQR $13,967–$29,435], p < 0.001) were higher among patients who developed a postoperative complication following a hepatectomy. A higher contribution margin ($12,421 [IQR $8440–$16,445] vs. $20,016 [IQR $14,212–$39,179], p < 0.001), as well as a twofold higher net profit was noted among patients who developed postoperative complication ($2788 [IQR $660–$5815] vs. $5515 [IQR $1068–$10,315], p < 0.001). Total hospital costs ($26,840 [IQR $21,318–$35,358] vs. $46,628 [IQR $31,974–$69,326], p < 0.001) as well as payments ($32,761 [IQR $26,394–$41,883] vs. $53,612 [IQR $38,548–$78,116], p < 0.001) were more than 1.5 times higher among patients who developed a postoperative complication following pancreatic resection. Contribution margins ($18,356 [IQR $14,024–$24,390] vs. $29,153 [IQR $20,256–$41,785], p < 0.001), as well as net profits ($5907 [IQR $2179–$9412] vs. $8114 [IQR $2518–$14,249], p < 0.001) were higher among patients who developed postoperative complication following pancreatic surgery.
Conclusions
A positive association was observed between net profits and postoperative complications. Future policies should target complications as a means to achieving a higher value for care.